Urbanization and climate changes have direct impacts on ecosystems and the services they provide to society, thus influencing human well-being and health. Urban sprawl may conflict with ecosystem services, e.g. enhancing water-related stresses and risks of, e.g., droughts and floods, with significant economic, environmental and societal impacts. Such hydro-climatic extremes and their societal impacts are evident around the world. East Africa is a region with highly vulnerable populations to frequent floods and droughts. To achieve long-term sustainable solutions to such water-related risks and problems, we need to understand and plan for the feedback mechanisms between population expansion and associated land-use changes and their impacts on ecosystem services. The potential of nature-based solutions to mitigate these risk and problems in urban development under climate change needs to be considered and accounted for in spatial planning and management strategies.